Home Birth Possible Medical Negligence

[Judey2020]

Hello.

I am here to ask advice. I had my daughter at home 18 months ago and she has since been diagnosed with Cerebral Palsy. I asked for a copy of my maternity notes following this news to check to see if everything was handled in the correct way during the birth. She is our first child so we cannot compare the birth to another and we don’t know anyone else who has had a home birth.

When my waters broke late on in the labour- just 30 minutes before she was born it was apparent meconium was present in the fluid. So, an ambulance was called in case of complications with potential to transfer to hospital before the birth. My daughter was however born shortly after this and the paramedics arrived just as I was giving birth.

She cried straight away when she was born and she was seemingly healthy on arrival. The midwives gave us the option to transfer to hospital to have our daughter checked and monitored because there was a higher risk of chest infection due to the meconium, but we were also given the option to monitor her from home. We decided on the latter because she seemed healthy and we thought we could look out for signs of a chest infection easily.

It has only become apparent in the last few days after consulting a senior midwife and asking questions about my maternity notes that the meconium was considered ‘thick’. I have looked up guidance on NICE which are the national guidelines and they state that a baby born in thick meconium should be monitored every 2 hours for the first 24 hours. So, I now feel we may have made the wrong decision not transferring to hospital.

I do however also feel like we were not given enough information at the time to make an informed decision and we were not aware of the risks as I believe it could amount to more than a chest infection. I am also wondering whether we should have been given a choice at all. It seemed very informal and non serious at the time but if I had read the guidelines I would have made a different decision.

There is an obvious link between meconium and asphyxiation which could lead to stroke/cerebral palsy in babies so this is why I am now wondering if this decision could have contributed to her condition.

I am wondering if we would have a case against the NHS for not giving us the information to make an informed decision or giving us a choice whether to go to hospital where actually the guidelines are very clear that the baby should be closely monitored after this event.

Any advice, guidance or similar experiences would be greatly appreciated.

Thanks for everyone's input. I appreciate your thoughts. I have already spoken with the someone senior who heads up the maternity team at the hospital and she is aware of our experience so she will be able to feedback to relevant midwives and ensure things are made clearer for future mothers under their care. So from this aspect I already feel glad I have raised the issue.

My thoughts now are that if we could be entitled to some compensation this could help pay for treatment and rehabilitation we are currently paying for and for ongoing treatment she will likely need in years to come.

Op, this is exactly why my cousin looked into it. She has a lot of potential expense involved with her disabled child and wanted to be able to feel she understood what had happened and got everything her child was entitled to.

Even though she didn’t have a case she is really pleased she got the opinion. I spoke to Iona who I mentioned up thread with my cousin and she was very calm and caring. My cousin got a medical opinion from an expert which said it wasn’t the medics fault and that gave her closure.

I think if you have a good solicitor and see where you get to then you will know you have done what you can

My DD had meconium in the waters (went late on, at about 7cm after quite quick labour). No idea how thick it was, but meant I was transferred up to the consultant led unit from the MLU, and we had some decelerations of HR in labour, plus cord round ankle and a very blue foot.

She had 2 hourly obs for the next 12h (temperature, pulse, respiration only) and the standard paediatric check for (same as DS who was much more routine)

So I'm not convinced that the basic obs would have picked anything up...

"meconium is the baby pooing due to distress"

Sometimes but not always, it can just be because baby is post dates, and if there are no other signs of distress (eg reduced heart rate) then it's not necessarily a concern.

As far as I understand it, when there's meconium in the waters you have to transfer into hospital, and the midwives did call an ambulance when the meconium was found (even though baby was born before it arrived, which wasn't their fault). I wonder if they monitored baby's heartbeat more frequently after that. I think that's all they could do tbh.

@Volcanicorange I can see where you are coming from. A home birth sounds terrifying to me, no medical equipment or staff nearby.
I was classed as 'high risk' due to gestational diabetes and reduced movements. I was continuously on a CTG, which picked up a dipping heartbeat with contractions, hence two doctors in, saying we need to get this baby out ASAP, cut and forceps and vontouse cup. Then he was taken to NICU and needed tube feeding, a tongue tie fixed, his temperature raised, blue light treatment for jaundice and they tested his blood cord cases for oxygen deprivation, of which they were on the cusp of normal. If I had been at home, I can't even think what could have happened

Just as a heads up medical negligence cases take YEARS. I speak from experience here, it took my parents 15 years to successfully win their medical negligence case which left my sister with CP.

But we can't question why the OP chose a home birth. Perhaps she wasn't aware of the potential risks. Did they properly tell you the pros and cons of a home birth?

Sorry that makes no sense what I mean is my sister was born with CP as a result of medical negligence.

Thick meconium in the waters may well be down to a hypoxic event whilst in the womb. If her heart rate was fine during labour and she was not grunting or struggling to breathe within the first day after being born, I would think that she already had cerebral palsy. I am a midwife.

The reason why such cases take years is so the child can be fully assessed as they get older to see how bad (or not) the damage is. It’s to make sure they get the correct amount of compensation. Some potential issues wouldn’t be apparent at 18 months.

Korma. I absolutely disagree with you. Anybody who has just given birth after a 15h labour is in no position to make informed decision especially if they haven’t been informed.

Moreover, medical decisions that not only affect yourself but your child as well should ALWAYS be made by a professional.

Also can people stop criticising making the choice to have a home birth.

Those comments would be less mean if op were considering this and hadn’t yet done it, or if op had done it already and had an uneventful birth, but in this context it is pointless and unkind.

I sought professional advice about my hb. I was told it was safe. I’m sure op asked her mw the same question and like any patient she was entitled to rely on that advice

But we can't question why the OP chose a home birth. Perhaps she wasn't aware of the potential risks. Did they properly tell you the pros and cons of a home birth?

Pregnant women get given written leaflets advising on 'birth choices'. It clearly states that first time mum's are advised to have a hospital birth as the risks are higher. This will also have been discussed at the 'birth plan' appointment when OP said she wanted a home birth. (assuming this is OP's first baby)

Op chose to have a home birth and not the standard option of a hospital birth, for reasons known to her. It is likely, since the baby produce meconium during birth, that the event causing the CP was either during the home birth OP chose, or during pregnancy.

A succesful medical negligence claim has to show:

1. negligence
2. that the negligence directly led to the outcome.

Even if OP could demonstrate negligence around being allowed to refuse to go to hospital, how would you prove that this caused the CP, and not the homebirth?

Many medical negligence claims centre around hospital births as there is more evidence, e.g. a CTG tracing showing the baby in distress which wasn't acted upon in the expected time.

*Korma. I absolutely disagree with you. Anybody who has just given birth after a 15h labour is in no position to make informed decision especially if they haven’t been informed.

Moreover, medical decisions that not only affect yourself but your child as well should ALWAYS be made by a professional.*

No, this is incorrect. In the UK people are assumed to have capacity unless the demonstrate that they don't. Pregnancy and childbirth do not remove a person's capacity, otherwise every woman in childbirth would be strongarmed into the most appropriate treatment and not allowed to refuse.

Medical decisions are made by professionals and presented to patients, who can accept or decline. NO medical professional in the UK would advise a 1st time mum to have a homebirth.

An ambulance was called and OP was advised to go to hospital to have the baby monitored. She chose to not go, which was an option based on her capacity to chose. Fromt he sounds of it, the baby was fine and did not develop pneumonia or respiratory distress, so this decision was not unreasonable. The baby would have been checked the following day by a midwife, who did not advise further action.

@Volcanicorange are you absolutely certain that leaflet is given in every are? I certainly didn’t get a leaflet like that.

If op had an independent mw or a hole birth supporting mw team the advice she got might have Ben very different. My SIL was advised by an nhs mw team that she was safe to have a hb with a first baby. She ended up being induced in the event, in hospital, but was never told hb not safe if she hadn’t been overdue.

Area not are!

@Volcanicorange just looked at the nhs website on place of birth for first births. It doesn’t say women having a first baby shouldn’t have a hb, just that risks of adverse events are “slightly higher”:

“ Home birth

If you have a straightforward pregnancy, and both you and the baby are well, you might choose to give birth at home. In England and Wales, just over 1 in 50 pregnant women give birth at home.

Giving birth is generally safe wherever you choose to have your baby.

But for women having their first baby, home birth slightly increases the risk of serious problems for the baby – including death or issues that might affect the baby's quality of life – from 5 in 1,000 for a hospital birth to 9 in 1,000 for a home birth.

For women having their second or subsequent baby, a planned home birth is as safe as having your baby in hospital or a midwife-led unit.”

Someone1987

"A home birth sounds terrifying to me, no medical equipment or staff nearby."

Utter nonsense, a home birth is not an unassisted birth (or "free birth"), you get two midwives attending and they do have medical equipment. If necessary an ambulance is called and then you also have paramedics and their equipment.

Obviously you don't have access to all the doctors, equipment and facilities that you'd have in a hospital, but you do have medical assistance from the midwives. In fact, you arguably have better care since you get two midwives to yourself (unlike in hospital when you're lucky if one midwife checks on you from time to time).

"If I had been at home, I can't even think what could have happened"

You wouldn't have been at home. Gestational diabetes and reduced movement are both risk factors that would mean you would have to be in hospital and not at home.

I had a home birth, it is not appropriate for every woman and every birth but it can be the lowest risk option and a very straightforward and positive experience. People are often very anti home birth on here and it pisses me off. Plus, as onceuponatime pointed out, it is really unhelpful and frankly unkind to criticise the OP for having a home birth at this point.

Of course, in a medical negligence case, it would probably be up for discussion.

@Volcanicorange are you absolutely certain that leaflet is given in every are? I certainly didn’t get a leaflet like that.

You get given huge amounts of leaflets during pregnancy. One of those is a leaflet on birth plan choices.

To have a home birth via the NHS (i.e have midwives attend) you need to talk about this with your midwife, who will give you information, more leaflets. The risks are outlined and documented. One of the problems with homebirths is they are 'hands off', there's no CTG demonstrating a baby in distress. How do you prove what caused the CP?

But for women having their first baby, home birth slightly increases the risk of serious problems for the baby – including death or issues that might affect the baby's quality of life – from 5 in 1,000 for a hospital birth to 9 in 1,000 for a home birth

There you go. So by choosing a home birth, you are accepting this almost doubling of risk. For a successful medical negligence claim you would nee to prove that the medical team/midwives did something wrong AND that this caused the CP, and not something during the unmonitored period of birth where the baby produced meconium

@NameChange30 the gestational diabetes did not cause my son to have the cord around his neck twice

No but it did mean you were in hospital where you and he got appropriate care. Glad it all worked out for you. Now please stop criticising other mothers for their choices - thanks

Thanks again for inputs. I hasten to add that in most other aspects of our care we were happy and I believe the midwives tried their best, however I do think being given more detailed information at the time and if the information was communicated to us differently then this would have changed our choice. On the basis of what we were told by the MWs at the time then I would still make the same decision to monitor our daughter from home.

Perhaps more research on our behalf before the birth could have helped but I think we were well read on normal aspects about birth and home births. I think as a patient you are allowed to be naive and allow the experts to guide your decisions.

There is a slight increased risk for HBs versus a hospital birth for delivery of your first child but the pros far outweighed the cons for us. And to say that anyone choosing a homebirth is taking a big risk is quite an ignorant thing to suggest. If the risks were so huge then it would not be endorsed by the medical profession in the way that it ia. It can have huge benefits for those who are suited to it.

Just to clarify paramedics were called by my partner... the midwives were pretty busy at the time and this was for a transfer to hospital for the birth in case the baby was in distress (the meconium being the potential indication). As it happened there was no time for this transfer and with fetal monitoring there was no indication at the time of the delivery or birth that there was any distress. Again, after birth our daughter was assessed and we believed she was perfectly healthy and did not undergo any problems during the birth.

I'm with @Volcanicorange on this one. Home births for first babies are riskier.

We are suing for birth negligence and are 6 years down the road with more to go.

OP has very little chance of success on the information she has given and the evidence that has been presented.

To succeed in a case you must prove negligence and that the negligence caused the injury. The matter of having meconium in the waters (generally a sign of distress) and not being directed that you must attend hospital for close monitoring, is a possible sign of negligence. The big but is the baby did not become ill from meconium inhalation, was well and not in any respiratory distress post birth or at home. Therefore the negligence (if any) did not cause the injury. Therefore no case on that basis.

However there was distress in labour and the baby may have, (during the 15 hour labour) become stuck, had cord compression, heartbeat decelerations and so on. My understanding of a home birth is that there isn't continuous monitoring? In a hospital birth there usually is a continuous CtG tracing which can be looked at by an expert and any problems pinpointed. If this is the case then there is negligence if the tracing became pathological and was ignored. There would be causation and you have a case.

I would advise OP to ask an experience negligence solicitor to look over the records as a whole to see if a problem occurred earlier which was not acted upon, but the meconium aspiration is a bit of a red herring I'm afraid.

Now please stop criticising other mothers for their choices

Competent adults are allowed to make any choice they like. They aren't entitled to sue people when those choices lead to a poor outcome.

OP - you say you knew the risks before hand of having a home birth. The pros outweighed the cons for you, as you assumed you wouldn't be one of the 9 in 1000, like everyone would. You were entitled to make this choice, and were supported to do so.
It seems more likely based on what you have said that an event pre/during birth caused you little ones CP, so I suspect a medical negligence claim will be unsuccessful.